Abnormal liver function most often does not appear for a long time and the diagnosis becomes late. In this case, treatment is often already not very effective. To assess the condition of the liver at an early stage, blood biochemistry, or rather the determination of the level of activity of hepatic transaminases, is of great importance. These liver enzymes (enzymes) are called indicator. Their activity is an accurate assessment of the state of the organ.
What it is?
Hepatic transaminases - what is it? These are special hepatic proteins (enzymes), they transamine cells, that is , they provide metabolism inside them. "Transaminases" - today the term is obsolete, the modern name is "aminotransferases."
Transaminase Properties
Transamination is one of the processes of nitrogen metabolism, in which new amino acids are synthesized by the transit of amino and keto acids without the release of ammonia. This was highlighted in 1937 by scientists M.G. Kritsman and A.E. Braunstein.
At the same time, direct and reverse reactions occur, i.e., a reversible transfer of amino groups from an amino acid to a keto acid. In this case, vit. AT 6.
The name of hepatic transaminases (and there are 2) is determined by the name of the acid itself involved in the amino group transit process: if it is aspartanic, then the enzyme is called aspartate aminotransferase (AST or AsAT), and if it is alanine, then it is alanine aminotransferase (ALT or AlAT). Each of them has its own characteristics.
Role in the body
Increased activity of hepatic transaminases - what is it? This is an increase in their level and it always speaks of necrosis of organ tissues and the presence of diseases. AST (aspartate aminotransferase) is an enzyme that is sensitive to changes in the myocardium, liver and brain. If their cells are not disturbed and function normally, AST does not increase.
ALT (alanine aminotransferase) is an enzyme that is the main indicator of hepatic changes.
Norms of indicators
Transaminase scores vary by sex and age. Normally, their number in women is 31 for ALT and AST; in men, ALT is 37 units / liter, and AST is 47 units / liter.
Diagnostic Principles
Aminotransferases are found in all cells of the body, but they are concentrated in the liver and heart. Therefore, the insufficiency of these organs can most quickly be judged by the level of these enzymes.
We can conclude, speaking about the activity of hepatic transaminases, that these are peculiar markers of inflammation. The fact is that the symptoms of the pathology appear only after 2 weeks, but cell death in various acute diseases (inflammation, cirrhosis or MI) leads to a sharp release of these enzymes into the blood, which can be used to judge if there is a problem.
That is, aminotransferases resemble leukocytes in speed of their appearance, but it is impossible to determine the nature of the pathology.
These are not specific tests, but reliable indicators of liver and heart pathologies. The combination of signs that the doctor produces helps to determine the circle of diseases and narrow it. For example, an increase in ALT + bilirubin is usually observed with cholecystitis.
Reasons for the increase
Hepatic transaminases are elevated with the development of hepatic and cardiac pathologies. It can be very dangerous. They speak:
- the presence of hepatitis (any form);
- Reye's syndrome - hepatic encephalopathy due to taking aspirin;
- steatosis;
- fibrosis;
- cirrhosis;
- cholestasis;
- tumors;
- metastases from other organs to the liver;
- Wilson’s disease or hepatocerebral dystrophy (congenital disorder of copper metabolism);
- myocardial infarction (with it, hepatic transaminases are always steadily elevated);
- parasitic infestations, because in the process of their life, parasites secrete toxins with the destruction of hepatocytes;
- liver injuries also lead to cell necrosis.
With cholestasis, stagnation of bile leads to overstretching of liver cells, metabolism is disrupted in them, and in the final chain of disorders, cells undergo necrosis.
Fatty degeneration of the liver also causes the destruction of normal liver cells and their replacement by fatty ones. With cirrhosis, cells are necrotic and replaced by coarse connective tissue. Tumors destroy not only hepatocytes, but also surrounding tissues, causing their inflammation.
Toxic processes in the liver have been proven after prolonged use of drugs, and an increase in transaminases occurs with the use of any form of drug release - tablets and infusions are equally harmful. Among them:
- analgesics, statins, antibiotics;
- anabolic steroid;
- NSAIDs;
- "Aspirin", "Paracetamol", MAO inhibitors ("Selegilin", "Imipramine");
- hormones;
- sulfonamides;
- barbiturates;
- cytostatics, immunosuppressants;
- iron and copper preparations also necrotic liver tissue.
While it was a question of persistent elevations of enzymes. But there is another type of increase - periodic.
A periodic or transient increase in hepatic transaminase activity may also be caused by other extrahepatic pathologies. It can occur in acute pancreatitis, hypothyroidism, obesity, mononucleosis, muscle injuries, burns, myodystrophy, bronze diabetes.
A slight increase in hepatic transaminases is a fairly common occurrence. It can be triggered by poor ecology, the intake of certain foods rich in, for example, nitrates, pesticides, trans fats. In any case, a deviation from the norm of enzymes in the form of their increase requires a visit to a doctor and a full examination. Especially when heaviness and pain in the right hypochondrium are added.
Ritis coefficient
The Italian scientist Fernando de Ritis proposed a different approach to assessing the activity of transaminases. In other words, in addition to quantifying each enzyme, the ratio of enzymes relative to each other should be determined - the Ritis coefficient.
The ratio of 0.9-1.7 is not a disease, usually the indicator is 1.33. If the coefficient fluctuates around 0-0.5, then this indicates the carriage of hepatitis viral etiology.
With values of 0.55-0.83, you can think about exacerbation of hepatitis. In other words, a coefficient <1 indicates infection and inflammation.
If K≥1 - this will indicate liver dystrophy and chronic hepatitis; K≥2 - hepatitis has an alcoholic etiology, or this indicates the development of myocardial infarction. The de Ritis coefficient is based on the fact that although ALT and AST are considered hepatic transaminases, ALT has a high concentration in the liver, and AST is distributed in almost equal amounts in the heart and liver.
Symptomatic manifestations of disorders
It should be noted that the symptoms of these disorders are always the same, regardless of the type of pathology. With an increase in hepatic transaminases, the symptoms are as follows:
- chronic lethargy and fatigue;
- bouts of sudden weakness; loss of appetite and nausea for no reason;
- aching pains in the stomach;
- heaviness in the right hypochondrium;
- bloating and gas buildup;
- generalized nocturnal itching of the skin;
- nosebleeds;
- dark urine and acholism of feces;
- possible yellowing of the skin;
- decreased activity and drowsiness are often observed.
Even if one symptom is noted, visiting a doctor does not interfere. Timeliness of treatment will get rid of the disease completely. Otherwise, the pathology becomes neglected and often irreversible.
Classification
To determine the level of hyperfermentemia, a special scale is used:
- Moderate degree - the level is increased slightly. This is possible with hepatitis of alcoholic or viral origin.
- Medium - indicators increased from the norm by 6 times - necrotic processes in the liver.
- A high level - an increase in the norm of 10 or more times - ischemia of the liver.
The acute condition caused by the disease causes the activity of transaminases: for example, with hepatitis, hyperfermentemia occurs on the 14-20th day of the disease, and then within a month the indicators are reduced to normal.
In the chronic course of the disease, during the period of remission, hyperfermentemia is not observed and the indicators are moderately or slightly increased. Latent cirrhosis will not show an increase in transaminases.
To make a diagnosis, the doctor must evaluate not only the increase in transaminases, but also their combination with other criteria. These indicators significantly narrow the range of pathologies. For example, jaundice or acute liver failure necessarily causes an increase in bilirubin. The concentration of enzymes may increase slightly. This is called bilirubin-aminotransferase dissociation. Such subtleties can only be determined by a specialist. Therefore, self-diagnosis and self-medication are excluded.
Excessive content of hepatic transaminases or hyperfermentemia is an indicator of liver dysfunction, indicating necrosis of liver cells. This condition can occur again, replacing normalization. This usually indicates the onset of a new inflammation or relapse of a chronic pathology.
What to do with an increase in aminotransferases?
Such a question is inappropriate, because the elimination of causative pathology will reduce the level of enzymes. There is no need to invent other methods. High numbers of transaminases indicate the need for urgent additional research and hospitalization.
In addition, the following may be assigned:
- various blood tests;
- electrolyte balance;
- ECG;
- Ultrasound
- CT
If necessary, determine the DNA of viruses in hepatitis, carry out PCR, as well as ELISA for antibodies. Since these analyzes have high prices, they are not prescribed without appropriate reasons.
Getting rid of the root causes, it is possible to reduce the level of liver enzymes. In this case, the restored system of the body will stop the release of transaminases into the blood.
As an additional therapy, you can use folk remedies. It is important to coordinate all actions related to treatment with a specialist in advance. Before use, it is necessary to examine and identify the exact causes. To improve liver health:
- Oatmeal. Oatmeal helps cleanse the body of harmful substances.
- Pumpkin will help to lower cholesterol. To prepare it, you need to boil it by adding honey first.
- Three times a day should drink a glass of water with the addition of 5 g of turmeric and 10 g of honey.
- Beet juice is also very beneficial for the liver. Use it after meals 3 times a day.
Value for treatment
The test for liver tests is sensitive to liver diseases, so it is often used to assess the dynamics of therapy in combination with other studies.
Liver diseases with hyperfermentemia always require their control in dynamics and appropriate therapy. Doctors take into account that the norm of enzymes does not always mean recovery. For latent cirrhosis, for example, the normal content of enzymes in the blood is characteristic. Therefore, it is necessary to be examined and undergo treatment by a doctor.